Successful treatment of an extensive oral verrucous hyperplasia with topical 5-aminolevulinic acid-mediated photodynamic therapy - case report

Our previous studies showed successful treatment of 13 oral verrucous hyperplasia (OVH) lesions and an extensive oral verrucous carcinoma with a topical 5-aminolevulinic acid-mediated photodynamic therapeutic (topical ALA-PDT) protocol (with a fluence rate of 100 mW/cm(2) and a light exposure dose of 100 J/cm(2)) using a 635-nm light-emitting diode (LED) light source. In this case report, we tested the efficacy of an enhanced topical ALA-PDT protocol (with a fluence rate of 200 mW/cm(2) and a light exposure dose of 200 J/cm(2)) for an extensive OVH lesion on the right buccal mucosa of a 43-year-old male smoker and areca quid chewer. The OVH lesion showed complete regression after 18 treatments of this enhanced topical ALA-PDT. Severe post-treatment pain was noted after each of the initial 6 treatments, and the patient needed strong analgesics (30 mg codeine phosphate 3 times daily) to control the pain. No recurrence of the OVH lesion was found after a follow-up period of 20 months. We suggest that our enhanced topical ALA-PDT protocol is very effective for treating OVH lesions. The treatment course may be slightly shortened with this enhanced protocol. However, severe post-PDT pain was experienced by the patient when the regression of tumor volume was large between 2 treatments.